Report of the Fifth Teaching Institute, Association of American Medical Colleges, by Helen H. Leeand Robert J. Glaser, editors. 262 pages, illustrated. Evanston, Ill., Association of American Medical Colleges, 1958. Cloth $5.00, paper $2.00
Intensive care unit–acquired infection (ICU-AI) and extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE) carriage are a major concern worldwide. Our objective was to investigate the impact of ESBL-PE carriage on ICU-AI. Our study is prospective, observational, and noninterventional. It was conducted over a 5-year period (Jan 2013–Dec 2017) in the medical-surgical intensive care unit of the Cayenne General Hospital (French Amazonia). During the study period, 1,340 patients were included, 271 (20.2%) developed ICU-AI, and 16.2% of these were caused by ESBL-PE. The main sites of ICU-AI were ventilator-associated pneumonia (35.8%) and primary bloodstream infection (29.8%). The main responsible microorganisms were Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae (ESBL-P in 35.8% of isolates), and Enterobacter cloacae (ESBL-P in 29.8% of isolates). Prior ESBL-PE carriage was diagnosed in 27.6% of patients with ICU-AI. In multivariable analysis, the sole factor associated with ESBL-PE as the responsible organism of ICU-AI was ESBL-PE carriage before ICU-AI (P < 0.001; odds ratio: 7.9 95% CI: 3.4-18.9). ESBL-PE carriers (74 patients) developed ICU-AI which was caused by ESBL-PE in 32 cases (43.2%). This proportion of patients carrying ESBL-PE who developed ICU-AI to the same microorganism was 51.2% in ESBL-P K. pneumoniae, 5.6% in ESBL-P Escherichia coli, and 40% in ESBL-P Enterobacter spp. NPV of ESBL-PE carriage to predict ICU-AI caused by ESBL-PE was above 94% and PPV was above 43%. Carriage of ESBL-P K pneumoniae and Enterobacter spp. is a strong predictor of ICU-AI caused by these two microorganisms.
Authors’ addresses: Hatem Kallel, Stephanie Houcke, Thibault Court, Cesar Roncin, Mathieu Raad, Didier Hommel, Intensive Care Unit, Cayenne General Hospital, Cayenne, French Guiana, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Dabor Resiere, Intensive Care Unit, Martinique University Hospital, Fort de France, Martinique, E-mail: firstname.lastname@example.org. Flaubert Nkontcho, Pharmacy Department, Cayenne General Hospital, Cayenne, French Guiana, E-mail: email@example.com. Magalie Demar, Laboratory of Microbiology, Cayenne General Hospital, Cayenne, French Guiana, E-mail: firstname.lastname@example.org. Jean Pujo, Emergency Department, Cayenne General Hospital, Cayenne, French Guiana, E-mail: email@example.com. Felix Djossou, Tropical and Infectious Diseases Department, Cayenne General Hospital, Cayenne, French Guiana, E-mail: firstname.lastname@example.org.